The impact of visual scanning in the laparoscopic environment after engaging in strain coping

OBJECTIVE

We aimed to determine whether visual scanning has a detrimental impact on the monitoring of critical signals and the performance of a concurrent laparoscopic training task after participants engaged in Hockey's strain coping. Strain coping refers to straining cognitive (attentional) resources joined with latent decrements (i.e., stress).

BACKGROUND

DeLucia and Betts (2008) reported that monitoring critical signals degraded performance of a laparoscopic peg-reversal task compared with no monitoring. However, performance did not differ between displays in which critical signals were shown on split screens (less visual scanning) and separated displays (more visual scanning). We hypothesized that effects of scanning may occur after prolonged strain coping.

METHOD

Using a between-subjects design, we had undergraduates perform a laparoscopic training task that induced strain coping. Then they performed a laparoscopic peg-reversal task while monitoring critical signals with a split-screen or separated display. We administered the NASA-Task Load Index (TLX) and Dundee Stress State Questionnaire (DSSQ) to assess strain coping.

RESULTS

The TLX and DSSQ profiles indicated that participants engaged in strain coping. Monitoring critical signals resulted in slowed peg-reversal performance compared with no monitoring. Separated displays degraded critical-signal monitoring compared with split-screen displays.

CONCLUSION

After novice observers experience strain coping, visual scanning can impair the detection of critical signals.

APPLICATION

Results suggest that the design and arrangement of displays in the operating room must incorporate the attentional limitations of the surgeon. Designs that induce visual scanning may impair monitoring of critical information at least in novices. Presenting displays closely in space may be beneficial.

Separated versus Integrated Displays in Minimally-Invasive Surgery

In minimally-invasive surgery (MIS), surgeons operate through small incisions while visualizing internal tissues with a camera or fiber optic scope. Compared with open surgery, MIS causes surgeons to engage in more frequent visual scanning to view multiple displays and other locations within the operating room. Visual scanning hastens fatigue, delays response time, and increases cognitive workload. We hypothesized that integrated displays– which present multiple images on a single monitor, would result in less fatigue, lower workload and better perceptual-motor performance than separated displays– which present images on physically separate monitors. Observers performed a pick-and-place task while monitoring “vital signs.” We compared performance between integrated and separated display conditions. Unexpectedly, results indicated that task completion time, fatigue and workload did not differ between display conditions. However, integrated displays did not degrade performance compared with separated displays. The implication is that integrated displays (i.e., fewer monitors) can be used in operating rooms. This is important because MIS requires more equipment than open surgery and operating rooms are typically cluttered with equipment.